Study: Kidney Disease Should Be Considered in Fluoroquinoline Prescribing

Vancouver, BC—The risk of acute kidney disease is small but significant among men using oral fluoroquinolines, according to
a new study that recommended those dangers be taken into consideration when prescribing and dispensing the antibiotics.

The study, published recently in the Canadian Medical Journal, also found a troubling interaction involving concomitant use of fluoroquinolones and renin-angiotensin-system blockers, according to the authors.

Background in the article notes that fluoroquinolone prescription labels carry a warning of kidney failure, but that often is not taken in consideration when the broad-spectrum antibiotics are prescribed for respiratory and urogenital infections.

To determine the risk of acute kidney injury with the use of oral fluoroquinolones, researchers from the U.S. and Canada looked at a group of 40-year-old men enrolled in the U.S. LifeLink Health Plan Claims Database between 2001 and 2011.

Looking at 1,292 cases of acute kidney disease compared to 12,651 controls, they found that current use of oral fluoroquinolones increased the risk of acute kidney injury by 2.18-fold (95% CI 1.74–2.73). Ciprofloxacin presented the highest risk, followed by moxifloxacin. Past use did not increase the risk; nor did the use of amoxicillin or azithromycin, according to the study.

Researchers also found that concurrent use of an oral fluoroquinolone and a renin-angiotensin-system blocker increases the risk of acute renal failure by 4.5 fold.

“We found a twofold increased risk of acute kidney injury requiring hospital admission with the use of fluoroquinolone antibiotics among adult men, using two analytic techniques,” write the authors, led by Mahyar Etminan, PharmD MSc, of the Child & Family Research Institute, University of British Columbia, and the Provincial Health Services Authority.

“The two-fold differential in risk in current users suggests that acute kidney injury secondary to fluoroquinolone use is an acute adverse event,” they added.
The authors also suggest that health care professionals need to be aware of the risks of kidney injury when the drugs are used.

“Although it is clear that the risk of death due to serious infections outweighs the risks associated with the use of fluoroquinolones, the potential for acute kidney injury raises the importance of vigilant prescribing,” they conclude.